Conservative management of bilateral femoral neck fractures in a child with autosomal dominant osteopetrosis

Abstract

Management of minimally displaced femoral neck fractures in paediatric patients with autosomal dominant osteopetrosis (ADO) remains unclear as only small numbers have been reported. There are no detailed reports on successful conservative treatment. Common causes of failure in this particular area include non-union and development of coxa vara. Although there are no quantitative studies, case reports have influenced most authors to recommend operative treatment. It is well recognised that operative treatment of osteopetrotic bone is challenging. Problems arise intraoperatively due to the bone hardness, and postoperatively due to altered biomechanics and defective remodelling. This case of a child with ADO who suffered two asynchronous compression-side stress fractures in the femoral neck demonstrates that non-operative management can be satisfactory. After 8 weeks with partial weight-bearing the fractures were stable. At the latest follow-up 2.5 and 4 years after the fractures the patient presented with an excellent clinical and radiological outcome. There was no development of coxa vara.

Rare Association of Bilateral Fracture of the Femoral Neck and Slipped Capital Femoral Epiphysis in Osteopetrosis Patient

“…We did a review and investigated reports describing association of neck femoral fractures as consequence of Osteopetrosis (ADO) [5][6][7][8], or atypical Slipped Capital Femoral Epiphysis with ADO [9][10][11].…”

“…Krieg, et al [6] support the surgical option as a recommended treatment especially in the neck of the femur, avoiding or decreasing the risks of non-union, coxa vara and subsequent avascular necrosis. The management of stress fractures of the femoral neck in pediatric patients with ADO remains controversial.…”

“…Decreasing the angle of the neck axis can also increase the chance of neck fracture due to a higher concentration of tension and shear force in patients with osteopetrosis [6] and increase the risk of degenerative arthritis over time [16,17,19].…”

“…There is even less information available, when the injury is accompanied by bilateral fractures and Slipped Femoral Capital Epiphysis, related to potential complications including suboptimal healing, avascular necrosis of the femoral head, nonunion, post-traumatic coxa vara, growth arrest, infection, and chondrolysis [6,7].…”

Total Hip Arthroplasty for Bilateral Femoral Neck Stress Fracture: A Case Report and Review of the Literature

“…Cases of bilateral femoral neck fractures, even simultaneous, have been reported in healthy military recruits [5][6][7][8][9] as well as in healthy nonathletes [10,11]. Insufficiency or fatigue bilateral fractures of the femoral neck have been described in various conditions such as pregnancy [12]; bone metabolic diseases, caused by osteomalacia associated with coxa vara [13] or by celiac disease [14]; vitamin D deficiency [15]; and rare genetic syndromes like Marfan [16] and autosomal dominant osteopetrosis [17]. Other more common risk factors, such as steroid treatment [18,19] and anorexia nervosa [20], have also been involved in cases of bilateral insufficiency femoral neck fractures.…”